Physician's Assistant

Patient Details

Sdec (283 days ago 08:51)

Sdec Fri 27 June 2025 08:51

Last Modified: 283 days ago

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Content:

Presenting Complaint:
Chest pain for 3 weeks in 25-week pregnant patient

Past Medical History:
• Migraine
• Low vitamin D
• Previous pregnancy 2022
• Psychotic disorder
• Suicidal thoughts
• Emotionally unstable personality disorder
• Serotonin syndrome
• Irritable bowel syndrome
• Coeliac disease
• Uterine fibroids
• Previous sexual abuse
• Fifth pregnancy (G5)

Diagnosis:
Suspected pulmonary embolism in pregnancy - pending VQ scan

I had the pleasure of meeting Fiona Peachy in Same Day Emergency Care today.

Ms Peachy is a 36-year-old lady who is 25 weeks pregnant (G5) presenting with a 3-week history of chest pain associated with breathing. She describes pleuritic chest pain with associated shortness of breath and dry cough without haemoptysis. She denies fever or calf pain. She has no family history of thromboembolism.

She had similar symptoms investigated during her previous pregnancy in 2022 with CT scanning, which excluded pulmonary embolism. Current symptoms feel different to her previous pregnancy.

She also reports lower abdominal pain and urinary symptoms suggestive of urinary tract infection. Recent abdominal ultrasound showed no pathology and no visualised uterine fibroids.

On examination, she appeared well with moist mucous membranes. Heart rate was 97 bpm (sinus tachycardia on ECG). Chest was clear to auscultation with normal heart sounds. No lower limb swelling or tenderness was noted.

Investigations:
• CRP: 16
• LFTs: Normal
• Troponin: <2
• FBC: Hb 100 (anaemic), WCC 9.7, Neutrophils 6.9
• VBG: Normal
• Chest X-ray: No pneumonia
• ECG: Sinus tachycardia 97 bpm
• Recent abdominal ultrasound: No pathology demonstrated

Plan:
1. VQ scan arranged to exclude pulmonary embolism (safer option than CT given previous radiation exposure and contrast allergy)
2. Prophylactic LMWH commenced pending scan result
3. Urine sample requested to exclude UTI
4. Continue iron supplementation for anaemia
5. Recommend folic acid supplementation
6. Midwife follow-up arranged (patient seeing named midwife Abby today)
7. Safety-netting advice given - return if symptoms worsen

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Patient Details

Sdec Fri 27 June 2025 08:51

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